Individual provider Active NPI

Robert E Carmody, M.D.

  • Anesthesiology Physician
  • Traverse City, MI
National Provider Identifier
1487633699
Registry record updated Apr 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301079384 Issued in MI
Practice address
4100 Park Forest Dr
Suite 210
Traverse City, MI 49684-7331
Phone
(231) 935-5770
Fax
(231) 935-0747
NPI assigned
Jan 16, 2006
Last updated
Apr 10, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301079384 MI Primary

Addresses

Primary practice location

4100 Park Forest Dr
Suite 210
Traverse City, MI 49684-7331

Mailing address

4100 Park Forest Dr
Suite 210
Traverse City, MI 49684-7331
Phone (231) 935-5770

Other identifiers 1

IdentifierTypeStateIssuer
1487633699MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100820000023 MI Practitioner - Anesthesiology 0143354589 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Wayne State University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical GroupGroup PAC ID 8820277015, 191 clinicians

Practice addresses (Care Compare)

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301079384MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Medical Group CurrentSince Jan 22, 2024 Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Anesthesiology CurrentSince Sep 7, 2024 Accepting new patients
Munson Medical Center Anesthesiology CurrentSince Feb 1, 2025 Accepting new patients
Munson Healthcare Cadillac CurrentSince Oct 20, 2025 Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Sep 7, 2024 Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Medical Group Current Accepting new patients
Munson Medical Group CurrentSince Jan 22, 2024 Accepting new patients
Munson Healthcare Cadillac Anesthesiology CurrentSince Oct 20, 2025 Accepting new patients
Munson Medical Center CurrentSince Feb 1, 2025 Accepting new patients
Munson Healthcare Cadillac Past Accepting new patients

Locations

2891 Momentum Pl
Chicago, IL 60689

3775 Momentum Pl
Chicago, IL 60689

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

825 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100

829 N Center Ave
Ste 210
Gaylord, MI 49735
Phone (989) 731-7860

419 S Coral St
Kalkaska, MI 49646
Phone (231) 258-7500

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1105 Sixth St
Ste 103
Traverse City, MI 49684
Phone (231) 935-6455

1200 Sixth St
Ste 200
Traverse City, MI 49684

4100 Park Forest Dr
Traverse City, MI 49684
Phone (231) 392-8900

4100 Park Forest Dr
Ste 210
Traverse City, MI 49684
Phone (231) 935-5770

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428624000000",
    "number": "1487633699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR",
            "address_2": "SUITE 210",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847331",
            "telephone_number": "231-935-5770",
            "fax_number": "231-935-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR",
            "address_2": "SUITE 210",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847331",
            "telephone_number": "231-935-5770",
            "fax_number": "231-935-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARMODY",
        "first_name": "ROBERT",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-16",
        "last_updated": "2015-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301079384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487633699",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.